For 42 years, the psychiatrist George Vaillant has been the chief curator of these lives, the chief investigator of their experiences, and the chief analyst of their lessons. His own life has been so woven into the study—and the study has become such a creature of his mind—that neither can be understood without the other. As Vaillant nears retirement (he’s now 74), and the study survivors approach death—the roughly half still living are in their late 80s—it’s a good time to examine both, and to do so, I was granted unprecedented access to case files ordinarily restricted to researchers.
As a young man, Vaillant fell in love with the longitudinal method of research, which tracks relatively small samples over long periods of time (as in Michael Apted’s Seven Up! documentaries).
Arlie Bock—a brusque, no-nonsense physician who grew up in Iowa and took over the health services at Harvard University in the 1930s—conceived the project with his patron, the department-store magnate W. T. Grant. Writing in September 1938, Bock declared that medical research paid too much attention to sick people; that dividing the body up into symptoms and diseases—and viewing it through the lenses of a hundred micro-specialties—could never shed light on the urgent question of how, on the whole, to live well. His study would draw on undergraduates who could “paddle their own canoe,” Bock said, and it would “attempt to analyze the forces that have produced normal young men.” He defined normal as “that combination of sentiments and physiological factors which in toto is commonly interpreted as successful living.”
Bock assembled a team that spanned medicine, physiology, anthropology, psychiatry, psychology, and social work, and was advised by such luminaries as the psychiatrist Adolf Meyer and the psychologist Henry Murray. Combing through health data, academic records, and recommendations from the Harvard dean, they chose 268 students—mostly from the classes of 1942, ’43, and ’44—and measured them from every conceivable angle and with every available scientific tool.
Exhaustive medical exams noted everything from major organ function, to the measure of lactic acid after five minutes on a treadmill, to the size of the “lip seam” and the hanging length of the scrotum. Using a new test called the electroencephalograph, the study measured the electrical activity in the brain, and sought to deduce character from the squiggles. During a home visit, a social worker took not only a boy’s history—when he stopped wetting his bed, how he learned about sex—but also extensive medical and social histories on his parents and extended family. The boys interpreted Rorschach inkblots, submitted handwriting samples for analysis, and talked extensively with psychiatrists. They stripped naked so that every dimension of their bodies could be measured for “anthropometric” analysis, a kind of whole-body phrenology based on the premise that stock character types could be seen from body proportions.
Vaillant says his hopeful temperament is best summed up by the story of a father who on Christmas Eve puts into one son’s stocking a fine gold watch, and into another son’s, a pile of horse manure. The next morning, the first boy comes to his father and says glumly, “Dad, I just don’t know what I’ll do with this watch. It’s so fragile. It could break.” The other boy runs to him and says, “Daddy! Daddy! Santa left me a pony, if only I can just find it!”
The story gets to the heart of Vaillant’s angle on the Grant Study. His central question is not how much or how little trouble these men met, but rather precisely how—and to what effect—they responded to that trouble. His main interpretive lens has been the psychoanalytic metaphor of “adaptations,” or unconscious responses to pain, conflict, or uncertainty. Formalized by Anna Freud on the basis of her father’s work, adaptations (also called “defense mechanisms”) are unconscious thoughts and behaviors that you could say either shape or distort—depending on whether you approve or disapprove—a person’s reality.
Vaillant explains defenses as the mental equivalent of a basic biological process. When we cut ourselves, for example, our blood clots—a swift and involuntary response that maintains homeostasis. Similarly, when we encounter a challenge large or small—a mother’s death or a broken shoelace—our defenses float us through the emotional swamp. And just as clotting can save us from bleeding to death—or plug a coronary artery and lead to a heart attack—defenses can spell our redemption or ruin. Vaillant’s taxonomy ranks defenses from worst to best, in four categories.
At the bottom of the pile are the unhealthiest, or “psychotic,” adaptations—like paranoia, hallucination, or megalomania—which, while they can serve to make reality tolerable for the person employing them, seem crazy to anyone else. One level up are the “immature” adaptations, which include acting out, passive aggression, hypochondria, projection, and fantasy. These aren’t as isolating as psychotic adaptations, but they impede intimacy. “Neurotic” defenses are common in “normal” people. These include intellectualization (mutating the primal stuff of life into objects of formal thought); dissociation (intense, often brief, removal from one’s feelings); and repression, which, Vaillant says, can involve “seemingly inexplicable naïveté, memory lapse, or failure to acknowledge input from a selected sense organ.” The healthiest, or “mature,” adaptations include altruism, humor, anticipation (looking ahead and planning for future discomfort), suppression (a conscious decision to postpone attention to an impulse or conflict, to be addressed in good time), and sublimation (finding outlets for feelings, like putting aggression into sport, or lust into courtship).
Most psychology preoccupies itself with mapping the heavens of health in sharp contrast to the underworld of illness. “Social anxiety disorder” is distinguished from shyness. Depression is defined as errors in cognition. Vaillant’s work, in contrast, creates a refreshing conversation about health and illness as weather patterns in a common space. “Much of what is labeled mental illness,” Vaillant writes, “simply reflects our ‘unwise’ deployment of defense mechanisms. If we use defenses well, we are deemed mentally healthy, conscientious, funny, creative, and altruistic. If we use them badly, the psychiatrist diagnoses us ill, our neighbors label us unpleasant, and society brands us immoral.”
This perspective is shaped by a long-term view. Whereas clinicians focus on treating a problem at any given time, Vaillant is more like a biographer, looking to make sense of a whole life—or, to take an even broader view, like an anthropologist or naturalist looking to capture an era. The good news, he argues, is that diseases—and people, too—have a “natural history.” After all, many of the “psychotic” adaptations are common in toddlers, and the “immature” adaptations are essential in later childhood, and they often fade with maturity. As adolescents, the Grant Study men were twice as likely to use immature defenses as mature ones, but in middle life they were four times as likely to use mature defenses—and the progress continued into old age. When they were between 50 and 75, Vaillant found, altruism and humor grew more prevalent, while all the immature defenses grew more rare.
This means that a glimpse of any one moment in a life can be deeply misleading. A man at 20 who appears the model of altruism may turn out to be a kind of emotional prodigy—or he may be ducking the kind of engagement with reality that his peers are both moving toward and defending against. And, on the other extreme, a man at 20 who appears impossibly wounded may turn out to be gestating toward maturity.
What allows people to work, and love, as they grow old? By the time the Grant Study men had entered retirement, Vaillant, who had then been following them for a quarter century, had identified seven major factors that predict healthy aging, both physically and psychologically.
Employing mature adaptations was one. The others were education, stable marriage, not smoking, not abusing alcohol, some exercise, and healthy weight. Of the 106 Harvard men who had five or six of these factors in their favor at age 50, half ended up at 80 as what Vaillant called “happy-well” and only 7.5 percent as “sad-sick.” Meanwhile, of the men who had three or fewer of the health factors at age 50, none ended up “happy-well” at 80. Even if they had been in adequate physical shape at 50, the men who had three or fewer protective factors were three times as likely to be dead at 80 as those with four or more factors.
What factors don’t matter? Vaillant identified some surprises. Cholesterol levels at age 50 have nothing to do with health in old age. While social ease correlates highly with good psychosocial adjustment in college and early adulthood, its significance diminishes over time. The predictive importance of childhood temperament also diminishes over time: shy, anxious kids tend to do poorly in young adulthood, but by age 70, are just as likely as the outgoing kids to be “happy-well.” Vaillant sums up: “If you follow lives long enough, the risk factors for healthy life adjustment change. There is an age to watch your cholesterol and an age to ignore it.”
The study has yielded some additional subtle surprises. Regular exercise in college predicted late-life mental health better than it did physical health. And depression turned out to be a major drain on physical health: of the men who were diagnosed with depression by age 50, more than 70 percent had died or were chronically ill by 63. More broadly, pessimists seemed to suffer physically in comparison with optimists, perhaps because they’re less likely to connect with others or care for themselves.
Vaillant’s other main interest is the power of relationships. “It is social aptitude,” he writes, “not intellectual brilliance or parental social class, that leads to successful aging.” Warm connections are necessary—and if not found in a mother or father, they can come from siblings, uncles, friends, mentors. The men’s relationships at age 47, he found, predicted late-life adjustment better than any other variable, except defenses. Good sibling relationships seem especially powerful: 93 percent of the men who were thriving at age 65 had been close to a brother or sister when younger. In an interview in the March 2008 newsletter to the Grant Study subjects, Vaillant was asked, “What have you learned from the Grant Study men?” Vaillant’s response: “That the only thing that really matters in life are your relationships to other people.”
Vaillant also dramatically expanded his scope by taking over a defunct study of juvenile delinquents in inner-city Boston, run by the criminologists Sheldon and Eleanor Glueck. Launched in 1939, the study had a control group of nondelinquent boys who grew up in similar circumstances—children of poor, mostly foreign-born parents, about half of whom lived in a home without a tub or a shower. In the 1970s, Vaillant and his staff tracked down most of these nondelinquent boys—it took years—so that today the Harvard Study of Adult Development consists of two cohorts, the “Grant men” and the “Glueck men.” Vaillant also arranged to interview a group of women from the legendary Stanford Terman study, which in the 1920s began to follow a group of high-IQ kids in California.
In contrast to the Grant data, the Glueck study data suggested that industriousness in childhood—as indicated by such things as whether the boys had part-time jobs, took on chores, or joined school clubs or sports teams—predicted adult mental health better than any other factor, including family cohesion and warm maternal relationships. “What we do,” Vaillant concluded, “affects how we feel just as much as how we feel affects what we do.”
But Vaillant has largely played down the distinctions among the samples. For example, while he allows that, in mortality rates, the inner-city men at age 68 to 70 resembled the Terman and Harvard cohorts at 78 to 80, he says that most of the difference can be explained by less education, more obesity, and greater abuse of alcohol and cigarettes. “When these four variables were controlled,” he writes, “their much lower parental social class, IQ, and current income were not important.” But of course those are awfully significant variables to “control.” Vaillant points out that at age 70, the inner-city men who graduated from college were just as healthy as the Harvard men. But only 29 Glueck men did finish college—about 6 percent of the sample.
In fact, Vaillant went on, positive emotions make us more vulnerable than negative ones. One reason is that they’re future-oriented. Fear and sadness have immediate payoffs—protecting us from attack or attracting resources at times of distress. Gratitude and joy, over time, will yield better health and deeper connections—but in the short term actually put us at risk. That’s because, while negative emotions tend to be insulating, positive emotions expose us to the common elements of rejection and heartbreak.
[Vaillant] has written, “reaction formation allows us to care for someone else when we wish to be cared for ourselves.” But in intimate relationships, he continued, the defense “rarely leads to happiness for either party.”Source: The Atlantic (June2009)
Subjects: Articles & Links, Excerpts, Psychology | Behavior
